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I = ' PPLICATION FOR SANITATIOK PERMIT Permit No. 9- s - (Complete in Duplicate) Date Issued .__�� i Application is hereby made to the San Joaquin Local Health District for a permit to construct and ii�s#all th .cork herai de c d: This application is made in compliance with County Ordinance N . 549 ` = JOB ADDRESS AND LO TION•-- ----' --------------------- --- Owner's Name--------------- •• ------- ---- -- ----=-- ---------- -------------------------------------------- Phone----------------------------------- Address--------•-------- 1/ ------- ------- ---------- ---- Contractor's Name_________ '_ ,�- PhonesP �--_ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � oe �•.,,•• Number of living units: _�____ FR er of bedrooms .A- Number of baths -------- Lot size ---- _ - - _ --------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 fest: Sand ravel ❑ Sandy Loam eEJ lay Loam E] Clay E] Adobe ardpan E]Previous Application Made: Yes ❑ No New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se is available within 200 feet.) Septic Tan Distance from nearest well,41I,______ i tante froOdafion._: r _____.M t i I__ _ __ __._.No, of compartments______.__ ___________ �i'tance Liquid depth____ ________Capacity___ Disposal Field: Distance from near well_ from foundat' nA ___-____;___Distance to nearest I tne- ______ C} [ Number of lines___> ___ Length of each line_ ___ __.Width of french_�_r_�___ _ Q Type of filter materials e_ p - 9 De Depth of filter material____ __-________Total len th_____�r___ ____ __-_._________ 3 � Seepage Pit: Distance to nearest well___________ __________Distance from foundation--------------------Distance to nearest lot line--------._.-.____ i ❑ Number of pits----------------------Lining material------------_----------Size: Diameter-----------------------Depth-------------------__ k i Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------.---.------...____. G Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity -------gals. Privy: Distance from nearest well__5______________________________-_-___-____-__Distance from nearest building----------------._-_--__-________________- ❑ Distance to nearest lot line---------------------- ---------------------------------- -------- ---------- ------•---------------------------------------- 4 Remodeling and/or repairing fdescribe):_---• ---------- -''kms" ------------------------------------- ---- ----------------------- - ------------ -------------------_-- -------------------------------------------------------------------.--•------------------------------------------------------------------- ---------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County. ordinances, State laws, and rules and regulations of the San Joaquin Lo al Health District. 1 ner n )n(Signed)------------- oractor) BY:------------ -------*---- ---- -------- --,. -- ----------- --------------------------------------------(Title)------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FO�Rli)f PARTM NT USE = NLY APPLICATION ACCEPTED BY------ r44 A-4"_ :_: "' " -_. DATE__-- _-- --- =/�----_- •-•-- ------ REVIEWED BY-------------------------------------------- ----------- T-=--------- ----------------------------------------------- DATE---- / BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------.------------_------ # Alterations and/or recommendations------------- ------ -------------------------------------------------------------------------------------------- e ---------:L---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ------------------•--------------------------------------------------- --------------------OJOAQUIN ---------------- ------------------------------------------------------------------------------------------ _..-_. FINALINSPECTION BY------------------------------- ------- ------------ Date-------------- -A--- -------------------------- SA LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+reet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California , ES-9-2M 8-51 Revised W-2100